I was reminded recently of my connections with Princeton and indirectly The Institute for Advanced Study when watching the 2023 film Oppenheimer, a cinematographic biography of J Robert Oppenheimer. I was born in October 1948, by chance in the United States when my parents were living in Princeton New Jersey and where my father, a mathematician, was a fellow for two years at The Institute for Advanced Study.
J Robert Oppenheimer was the theoretical physicist who headed the Los Alamos Laboratory of the Manhattan Project that culminated in the detonation of the first atom bomb in 1945 in New Mexico and subsequently the atomic bombs dropped on the cities of Hiroshima and Nagasaki that ended the Second World War. At the time of my birth both Albert Einstein and Robert Oppenheimer were at the Institute for Advanced Study and although my father’s field of mathematical study was somewhat different from theirs, he spoke of attending seminars at which both Einstein and Oppenheimer participated.
Reminiscences and history are said to be the province of old men and women, and watching the Oppenheimer film, my thoughts went back to my father, a complex man, in some ways similar to the flawed and eccentric but brilliant J Robert Oppenheimer. My father, as was Oppenheimer, a distant parent but with a determined work ethic that left its mark on me to this day. As a young boy I was always expected to be doing something constructive and complaints of boredom were not tolerated.
Much to my father’s disappointment, I followed a career in medicine which my father regarded as a science of lesser importance compared with mathematics and physics! I nevertheless applied the principles of logic and rigorous analysis, similar to that required in mathematics and physics, in both my clinical and managerial careers. Criticised as being a rigid and autocratic manager, even without feeling for those less fortunate, my approach was always based on logic and analysis. Following this train of thought, I reflected on my career as a manager of health services in South Africa and the difficult decisions that I took as part of my work.
Far removed from world altering events such as the detonation of an atomic bomb, nevertheless during my career as a health manager I was faced by many difficult decisions. One of the most challenging was to implement steps necessitated by a budget shortfall imposed on the department by a national policy decision. These included the reduction of services to balance a budget, which created an explosion of another sort. A public outcry resulted and as a result criticism followed me even after my retirement.
Now in 2023, due to various factors, many self-inflicted, the South African government is facing a budgetary crisis, likened by some to careering off a fiscal cliff. The South African government, despite facing massive borrowing to fund budget deficits, relented to union pressures granting public sector workers unaffordable salary increases that has added over R37 billion to government expenditure. With no other sources of funding and further borrowing unwise, the National Treasury determined that this deficit must be funded through budget cuts by all government departments, including health and education. My colleagues in the health department that I once headed are now faced by budgetary shortfalls that make those that I faced pale into insignificance with potentially dire consequences for those citizens dependent on public health services.
Faced with an unpleasant truth, whether it is a diagnosis of cancer or reducing health services to match an inadequate financial envelope, the first reactions are anger seeking to apportion blame and denial. The feeling is that what is happening cannot be possible and that it must be someone’s fault. However, while it may well be, it serves little purpose to rail against what is reality. Depression and inertia may follow but finally, and it is not always the case, it becomes necessary to accept reality and progress from there.
In the case of a cancer diagnosis, the decision could be either to embark on aggressive cancer treatment with all that this entails or decide to rather accept a prognosis without curative treatment and embark on palliation rather than cure.
Faced with budgetary shortfalls, those responsible for governance and management in the public health sector have no choice but to follow a similar path. Blame, anger and denial can be directed in various directions to little effect and if efforts to garner more funds fail, austerity measures will be required with implicit negative consequences.
Both Einstein and Oppenheimer, who with others created the science that lead to the nuclear age, in their later years became ardent opponents of the proliferation of nuclear weapons. In the case of Oppenheimer the consequence of this was being barred from positions of influence and further access to the United States nuclear program.
Oppenheimer chose to head the team developing the ultimate weapon of destruction and while the decision to utilise that weapon was not his, but that of President Truman, he also lived with the fact that he was indirectly responsible for the death of thousands of people. This fact lead him to say to President Truman, much to the President’s annoyance, that he, Oppenheimer, felt that he had blood on his hands. The President and his advisors had rationalised the use of nuclear weapons on a civilian population as the only means to reduce American deaths and end a bitter Pacific war against the Japanese. This decision remains controversial and an issue of debate almost 80 years later.
The lesson that I take from my musings is that decisions, big and small, have consequences and whether we like it or not we live with the consequences. Oppenheimer and Truman lived with their monumental decisions and South African policy makers and public service managers now unfortunately on the edge of a fiscal cliff and potential disaster will face and live with theirs. Another lesson that arises from my musings is that confronted by a difficult issue it takes courage to rise to the challenge and take a decision. But that it is better to take that a decision and live with the consequences than to do nothing frozen by indecision.
All this after viewing the 2023 Oppenheimer film! If you have not seen the film take my advice it is worthwhile taking the three hours to do so!
